USPTF Recommendations

Summary of
Recommendations for
Clinical Preventive Services
March 2015
These policy recommendations describe AAFP policy for a number of
clinical preventive services for general and specific populations.
These recommendations are provided only as assistance for physicians making clinical
decisions regarding the care of their patients. As such, they cannot substitute for the
individual judgment brought to each clinical situation by the patients family physician.
As with all clinical reference resources, they reflect the best understanding of the
science of medicine at the time of publication, but they should be used with the clear
understanding that continued research may result in new knowledge and
recommendations.
American Academy of Family Physicians

11400 Tomahawk Creek Parkway, Leawood KS 66211-2672
913-906-6000 http://www.aafp.org
800-274-2237
Introduction to
AAFP Summary of Recommendations
For Clinical Preventive Services
C Recommendation: The AAFP recommends
against routinely providing the service. There may
be considerations that support providing the service
in an individual patient. There is at least moderate
certainty that the net benefit is small.
D Recommendation: The AAFP recommends
against the service. There is moderate or high
certainty that the service has no net benefit or that
the harms outweigh the benefits.
I Recommendation: The AAFP concludes that
the current evidence is insufficient to assess the
balance of benefits and harms of the service.
Evidence is lacking, of poor quality, or conflicting,
and the balance of benefits and harms cannot be
determined.
I-HB
Healthy Behavior is identified as desirable
but the effectiveness of physicians advice and
counseling is uncertain.
The AAFP Summary of Recommendations for

Clinical Preventive Services (RCPS) is a document
that is periodically updated through the work of the
AAFPs Commission on Health of the Public and
Science (CHPS) and is approved by the AAFP
Board of Directors. The starting point for the
recommendations is the rigorous analysis of
scientific knowledge available as presented by the
United States Preventive Services Task Force
(USPSTF).
http://www.uspreventiveservicestaskforce.org/
The USPSTF conducts impartial assessments of
the scientific evidence for the effectiveness of a
broad range of clinical preventive services,
including screening, counseling, and preventive
medications.
The CHPS reviews recommendations released by
the USPSTF and makes recommendations to the
AAFP Board of Directors. In most cases the AAFP
agrees with the USPSTF, however, there are
circumstances where there are differences.
The AAFP grading system for those

recommendations before May 2007 includes:
SR Strongly Recommend: Good quality evidence
exists which demonstrates substantial net benefit
over harm; the intervention is perceived to be cost
effective and acceptable to nearly all patients.
R Recommend: Although evidence exists which
demonstrates net benefit, either the benefit is only
moderate in magnitude or the evidence supporting
a substantial benefit is only fair. The intervention is
perceived to be cost effective and acceptable to
most patients.
NR No Recommendation Either For or Against:
Either good or fair evidence exist of at least a small
net benefit. Cost-effectiveness may not be known
or patients may be divided about acceptability of
the intervention.
RA Recommend Against: Good or fair evidence
which demonstrates no net benefit over harm.
I
Insufficient Evidence to Recommend Either
for or Against: No evidence of even fair quality
exists or the existing evidence is conflicting.
I-HB
Healthy Behavior is identified as desirable
but the effectiveness of physicians advice and
counseling is uncertain.
In 2007, the USPSTF changed the grading of

evidence for new recommendations issued
(http://www.uspreventiveservicestaskforce.org/usps
tf/grades.htm). Therefore, the AAFP has also
changed its grading of the evidence to be more
consistent with the USPSTF. The USPSTF and
AAFP are in a transition period and are
implementing the use of two different grading
systems for the recommendations. The first
grading system applies to the recommendations
that occurred before May 2007, and the second
grading system applies to recommendations that
occurred during or after May 2007. These grading
systems are outlined below.
The AAFP grading systems for the
recommendations that occur during or after
May 2007 includes:
A Recommendation: The AAFP recommends the
service. There is high certainty that the net benefit
is substantial.
B Recommendation: The AAFP recommends
the service. There is high certainty that the net
benefit is moderate or there is moderate certainty
that the net benefit is moderate to substantial.
AAFP Policy Action November 1996,

March 2015 Order No. 1968
Where appropriate, specific website URLs are

provided which link directly to the clinical
consideration section of the U.S. Preventive
2
Services Task Force. The clinical consideration

section provides additional information needed to
interpret and implement the recommendations.
Physicians are encouraged to review not only the
needs of individual patients they see, but also of
the populations in the communities they serve to
determine which specific population
recommendations need to be implemented
systematically in their practices. The
recommendations contained in this document are
for screening, chemoprophylaxis and counseling
only. They do not necessarily apply to patients who
have signs and/or symptoms relating to a particular
condition.
These recommendations are provided only as
assistance for physicians making clinical decisions
regarding the care of their patients. As such, they
cannot substitute for the individual judgment
brought to each clinical situation by the patients
family physician. As with all clinical reference
resources, they reflect the best understanding of
the science of medicine at the time of publication,
but they should be used with the clear
understanding that continued research may result
in new knowledge and recommendations. These
recommendations are only one element in the
complex process of improving the health of
America. To be effective, the recommendations
must be implemented.
AAFP Recommendations for Genetic and
Genomic Tests
The AAFP Recommendations for Genetic
and Genomic Tests is provided to aid
members their delivery of evidence-based
practices to their patients. These
recommendations are updated periodically
through the work of the AAFPs Commission
on Health of the Public and Science (CHPS)
and are approved by the AAFP Board of
Directors. The starting point for the
recommendations is the rigorous analysis of
the scientific outcomes available as
presented by the Evaluation of Genomics in
Practice and Prevention Working Group
(EGAPP WG).
http://www.egappreviews.org/workingrp.htm
The CHPS reviews recommendations
released by the EGAPP WG and makes
recommendations to the AAFP Board of
Directors. The AAFP agrees with the EGAPP
WG in their recommendations whenever
possible; however, there may be
circumstances that could warrant different

recommendations.
The AAFP uses language consistent with the
language in the recommendations from the
EGAPP WG. The language is as follows:
Recommend for: The AAFP recommends
the test. There is evidence to support that the
magnitude of the effect of the test is
substantial, moderate or small (as opposed to
zero benefit).
Recommend against: The AAFP
recommends against the test. There is
evidence to support that the magnitude of the
effect of the test is zero or that there are net
harms.
Insufficient: The AAFP concludes that the
current evidence is insufficient to assess the
balance of benefits and harms of the test.
Where appropriate, specific website URLs
are provided which link directly to the clinical
consideration section of the EGAPP WG.
This section provides additional information
for interpreting and implementing the
recommendation.
These recommendations are provided only
as assistance for physicians making clinical
decisions regarding the care of their patients.
As such, they cannot substitute for the
individual judgment brought to each clinical
situation by the patients family physician. As
with all clinical reference resources, they
reflect the best understanding of the science
of medicine at the time of publication, but
they should be used with the clear
understanding that continued research may
result in new knowledge and
recommendations. These recommendations
are only one element in the complex process
of improving the health of America. To be
effective, the recommendations must be
implemented.

Summary of Recommendations for Clinical Preventive Services
Abdominal Aortic Aneurysm, Men
The AAFP recommends one-time screening for abdominal aortic aneurysm (AAA) by ultrasonography in
men ages 65 to 75 years who have ever smoked. (2014)
(Grade: B recommendation)
Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm
Clinical Considerations:
http://www.uspreventiveservicestaskforce.org/uspstf14/abdoman/abdomanfinalrs.htm#consider
The AAFP recommends that clinicians selectively offer screening for AAA in men ages 65 to 75 years who
have never smoked rather than routinely screening all men in this group. (2014)
(Grade: C recommendation)
Abdominal Aortic Aneurysm, Women
The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms
of screening for AAA in women ages 65 to 75 years who have ever smoked. (2014)
(Grade: I recommendation)
The AAFP recommends against routine screening for AAA in women who have never smoked. (2014)
(Grade: D recommendation)
Abuse, Intimate Partner Violence of Elderly

and Vulnerable Adults
The AAFP recommends that clinicians screen women of childbearing age for intimate partner violence
(IPV), such as domestic violence, and provide or refer women who screen positive to intervention
services. This recommendation applies to women who do not have signs or symptoms of abuse. (2013)
(Grade Definition:http://www.uspreventiveservicestaskforce.org/draftrec2.htm)
(Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf12/ipvelderfinalrs.htm)
The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms
of screening all elderly and vulnerable adults (physically or mentally dysfunctional) for abuse and neglect.
(2013) (Grade: I statement)
(Grade Definition: http://www.uspreventiveservicestaskforce.org/draftrec2.htm)
(Clinical Considerations:http://www.uspreventiveservicestaskforce.org/uspstf12/ipvelderfinalrs.htm)
Alcohol Misuse, Adults
Alcohol Misuse, Adolescents
Bacteriuria, Asymptomatic, Pregnant

Women
Bacteriuria, Asymptomatic, Men, NonPregnant
The AAFP recommends that clinicians screen adults aged 18 years or older for alcohol misuse and
provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to
reduce alcohol misuse. (2013)
Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm#post
http://www.uspreventiveservicestaskforce.org/uspstf12/alcmisuse/alcmisusefinalrs.htm#consider
The AAFP recognizes the avoidance of alcohol products by adolescents aged 12 to 17 years is desirable.
The effectiveness of the physician's advice and counseling in this area is uncertain. (2013)
http://www.uspreventiveservicestaskforce.org/uspstf12/alcmisuse/alcmisusefinalrs.htm#consider
The AAFP recommends screening for asymptomatic bacteriuria with urine culture for pregnant women at
12 to 16 weeks gestation or at the first prenatal visit, if later. (2008)
(Grade: A recommendation)
(Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm#post)
(Clinical Consideration: www.ahrq.gov/clinic/uspstf08/asymptbact/asbactrs.htm#clinical)
The AAFP recommends against screening for asymptomatic bacteriuria in men and nonpregnant women.
(2008)
(Clinical Consideration: http://www.ahrq.gov/clinic/uspstf08/bv/bvrs.htm#clinical)


Bacterial Vaginosis, Pregnant Women
The AAFP recommends against screening for bacterial vaginosis in asymptomatic pregnant women at low risk
for preterm delivery. (2008)
(Clinical Considerations: www.ahrq.gov/clinic/uspstf08/bv/bvrs.htm#clinical)
The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of
screening for bacterial vaginosis in asymptomatic pregnant women at high risk for preterm delivery. (2008)
(Clinical Considerations: http://www.ahrq.gov/clinic/uspstf08/bv/bvrs.htm#clinical)
The AAFP recommends offering or referring adults who are overweight or obese and have additional
Behavior Counseling, Healthful Diet and
Physical Activity for Cardiovascular Disease cardiovascular disease (CVD) risk factors to intensive behavioral counseling interventions to promote a
(CVD)
healthful diet and physical activity for CVD. (2014)
http://www.uspreventiveservicestaskforce.org/uspstf13/cvdhighrisk/cvdhighriskfinalrs.htm#consider
Behavioral Counseling to Prevent Sexually The AAFP recommends high-intensity behavioral counseling to prevent sexually transmitted infections (STIs)
Transmitted Infections
for all sexually active adolescents and for adults at increased risk for STIs. (2008)
(Clinical Consideration: http://www.ahrq.gov/clinic/uspstf08/sti/stirs.htm#clinical)
Behavioral Counseling to Prevent Sexually The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of
Transmitted Infections
behavioral counseling to prevent STIs in non-sexually active adolescents and in adults not at increased risk for
STIs. (2008)
(Clinical Considerations: http://www.ahrq.gov/clinic/uspstf08/sti/stirs.htm#clinical)
Bladder Cancer, Adults
The AAFP concludes that the evidence is insufficient to assess the balance of benefits and harms of screening
for bladder cancer in asymptomatic adults. (August 2011)
(Clinical Considerations:
http://www.uspreventiveservicestaskforce.org/uspstf11/bladdercancer/bladcanrs.htm#clinical)
Breast Cancer, Mammography
Family physicians should discuss with each woman the potential benefits and harms of breast cancer
screening tests and develop a plan for early detection of breast cancer that minimizes potential harms. These
discussions should include the evidence regarding each screening test, the risk of breast cancer, and individual
patient preferences. The recommendations below are based on current best evidence as summarized by the
United States Preventive Services Task Force (USPSTF) and can help to guide physicians and patients.
These recommendations are intended to apply to women who are not at increased risk of developing breast
cancer and only apply to routine screening procedures.
The AAFP recommends that the decision to conduct screening mammography before age 50 should be
individualized and take into account patient context including her risks as well as her values regarding specific
benefits and harms. (January 2010)
(Grade C Recommendation)
Clinical Considerations: http://www.ahrq.gov/clinic/uspstf09/breastcancer/brcanrs.htm#clinical
The AAFP recommends biennial (every two years) screening mammography for women between ages 50 and
74. (January 2010)
(Grade B recommendation)
The AAFP concludes that the current evidence is insufficient to assess the benefits and harms of screening
mammography in women aged 75 years and older. (January 2010)
(Grade I recommendation)


Breast Cancer, Self BSE
Breast Cancer, Clinical Examination (CBE)
Breast Cancer, Digital Mammography or

MRI
Breast Cancer, Prevention Medication
Breast Cancer/BRCA Mutation Testing
screening tests and develop a plan for early detection of breast cancer that minimizes potential harms.
These discussions should include the evidence regarding each screening test, the risk of breast cancer, and
individual patient preferences. The recommendations below are based on current best evidence as
summarized by the United States Preventive Services Task Force (USPSTF) and can help to guide
physicians and patients. These recommendations are intended to apply to women who are not at increased
risk of developing breast cancer and only apply to routine screening procedures.
The AAFP recommends against clinicians teaching women Breast Self-Examination (BSE). (January 2010)
(Grade D recommendation)
The AAFP concludes that the current evidence is insufficient to assess the benefits and harms of clinical
breast examination (CBE) for women aged 40 years and older. (January 2010)
The AAFP concludes that current evidence is insufficient to assess benefits and harms of either digital
mammography or MRI instead of film screen mammography as screening modalities for breast cancer.
(January 2010) (Grade: I recommendation)
The AAFP recommends that clinicians engage in shared, informed decision making with women who are at
increased risk for breast cancer about medications to reduce their risk. For women who are at increased risk
for breast cancer and at low risk for adverse medication effects, clinicians should offer to prescribe riskreducing medications such as tamoxifen or raloxifene. (2013)
(Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm)
http://www.uspreventiveservicestaskforce.org/uspstf13/breastcanmeds/breastcanmedsrs.htm#consider
The AAFP recommends against the routine use of medications, such as tamoxifen or raloxifene, for risk
reduction of primary breast cancer in women who are not at increased risk for breast cancer. (2013)
http://www.uspreventiveservicestaskforce.org/uspstf13/breastcanmeds/breastcanmedsrs.htm#consider
The AAFP recommends that primary care providers screen women who have family members with
breast, ovarian, tubal, or peritoneal cancer with one of several screening tools designed to identify a
family history that may be associated with an increased risk for potentially harmful mutations in breast
cancer susceptibility genes (BRCA1 or BRCA2). Women with positive screening results should receive
genetic counseling and, if indicated after counseling, BRCA testing. (2013)
Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm#brec
(Clinical Consideration:
http://www.uspreventiveservicestaskforce.org/uspstf12/brcatest/brcatestfinalrs.htm#consider)
The AAFP recommends against routine genetic counseling or BRCA testing for women whose family
history is not associated with an increased risk for potentially harmful mutations in the BRCA1 or BRCA2
genes. (2013)
(Grade: D Recommendation)
Clinical Consideration:
http://www.uspreventiveservicestaskforce.org/uspstf12/brcatest/brcatestfinalrs.htm#consider


Breastfeeding, Structured Education and

Counseling
Cardiovascular Disease, Aspirin for the

Prevention of

Prevention of

Prevention of

Prevention of
Cardiovascular Disease, Genomic Testing
Carotid Artery Stenosis, Adults
Cervical Cancer
The AAFP recommends interventions during pregnancy and after birth to promote and support
breastfeeding. (2008)
(Clinical Consideration: http://www.ahrq.gov/clinic/uspstf08/breastfeeding/brfeedrs.htm#clinical)
(For Definition of Interventions:
http://www.uspreventiveservicestaskforce.org/uspstf08/breastfeeding/brfeedsum.htm)
The AAFP recommends the use of aspirin for men age 45 to 79 years when the potential benefit due to a
reduction in myocardial infarctions outweighs the potential harm due to an increase in gastrointestinal
hemorrhage. (2009) (Grade: A recommendation)
(Clinical Considerations: http://www.ahrq.gov/clinic/uspstf09/aspirincvd/aspcvdrs.htm#clinical)
The AAFP recommends the use of aspirin for women age 55 to 79 years when the potential benefit of a
reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage.
(2009) (Grade: A recommendation)
Clinical Considerations: http://www.ahrq.gov/clinic/uspstf09/aspirincvd/aspcvdrs.htm#clinical
The AAFP recommends against the use of aspirin for stroke prevention in women younger than 55 years
and for myocardial infarction prevention in men younger than 45 years. (2009)
The AAFP concludes that the evidence is insufficient to assess the benefits and harms of aspirin for
cardiovascular disease prevention in men and women 80 years or older. (2009)
The AAFP recommends against genomics profiling to assess risk for cardiovascular disease. The net
health benefit from the use of any genomic tests for the assessment of cardiovascular disease risk is
negligible and there is no evidence that they lead to improved patient management or increased risk
reduction. (2012)
(Clinical Consideration: http://www.nature.com/gim/journal/v12/n12/pdf/gim2010136a.pdf (5-page PDF.
About PDFs)
The AAFP recommends against screening for asymptomatic carotid artery stenosis (CAS) in general adult
populations. (2014)
(Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm#drec)
http://www.uspreventiveservicestaskforce.org/uspstf13/cas/casfinalrs.htm#consider)
The AAFP recommends screening for cervical cancer in women age 21 to 65 years with cytology (Pap
smear) every 3 years or, for women age 30 to 65 years who want to lengthen the screening interval,
screening with a combination of cytology and human papillomavirus (HPV) testing every 5 years. (2012)
(Grade: A recommendations)
(Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm#arec)
http://www.uspreventiveservicestaskforce.org/uspstf11/cervcancer/cervcancerrs.htm#clinica)
The AAFP recommends against screening for cervical cancer in women younger than age 21 years.
(2012) (Grade: D recommendation)
http://www.uspreventiveservicestaskforce.org/uspstf11/cervcancer/cervcancerrs.htm#clinical)
The AAFP recommends against screening for cervical cancer in women older than age 65 years who have
had adequate prior screening and are not otherwise at high risk for cervical cancer. See the Clinical
Considerations for discussion of adequacy of prior screening and risk factors. (2012)
(Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm#arec
The AAFP recommends against screening for cervical cancer in women who have had a hysterectomy
with removal of the cervix and who do not have a history of a high-grade precancerous lesion (cervical
intraepithelial neoplasia [CIN] grade 2 or 3) or cervical cancer. (2012) (D recommendation)


Cervical Cancer
Ch,
Chlamydia, Women
Chlamydia, Men
Chronic Obstructive Pulmonary Disease,

Adults
Colorectal Cancer, Adults
Colorectal Cancer, Adults
Colorectal Cancer, Chemo Prevention
Colorectal Cancer, Chemo Prevention,

DNA Testing
Colorectal cancer, genomic testing
The AAFP recommends against screening for cervical cancer with HPV testing, alone or in combination with
cytology, in women younger than age 30 years. (2012) (D recommendation)
(Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm#arec )
The AAFP recommends screening for chlamydia and gonorrhea in sexually active women age 24 years and
younger and in older women who are at increased risk for infection. (2014)
(Grade: B Recommendation)
http://www.uspreventiveservicestaskforce.org/uspstf13/gonchlam/gonochlamfinalrs.htm#consider
screening for chlamydia and gonorrhea in men. (2014)
(Grade: I Recommendation)
The AAFP recommends against screening asymptomatic adults for chronic obstructive pulmonary disease
(COPD) using spirometry. (2008) (Grade: D recommendation)
(Clinical Considerations: www.ahrq.gov/clinic/uspstf08/copd/copdrs.htm#clinical)
The AAFP recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or
colonscopy, in adults, beginning at age 50 years and continuing until age 75 years. The risk and benefits of
these screening methods vary. (2008) (Grade: A recommendation)
(Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm#post) (Go to Rationale and
Clinical Consideration : http://www.ahrq.gov/clinic/uspstf08/colocancer/colors.htm)
The AAFP recommends against routine screening for colorectal cancer in adults age 76 to 85 years. There
may be considerations that support colorectal caner screening in an individual patient. (2008)
(Go to Rationale and Clinical Consideration : http://www.ahrq.gov/clinic/uspstf08/colocancer/colors.htm
The AAFP recommends against screening for colorectal cancer in adults older than age 85 years. (2008)
(Go to Rationale and Clinical Consideration : http://www.ahrq.gov/clinic/uspstf08/colocancer/colors.htm)
The AAFP recommends against the routine use of aspirin and non-steroidal anti-inflammatory drugs (NSAIDs)
to prevent colorectal cancer in individuals at average risk for colorectal cancer. (2008)
(Clinical Considerations: www.ahrq.gov/clinic/uspstf07/aspcolo/aspcolors.htm#clinical)
The AAFP concludes that the evidence is insufficient to assess the benefits and harms of computed
tomographic colongraphy and fecal DNA testing as screening modalities for colorectal cancer. (2008)
(Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm#post
(Clinical Considerations: http://www.ahrq.gov/clinic/uspstf08/colocancer/colors.htm
The AAFP recommends offering genetic testing for Lynch syndrome to patients newly diagnosed with
colorectal cancer to reduce morbidity and mortality in relatives. Genetic testing should be offer to first degree
relatives of those found to have Lynch syndrome, and those positive for Lynch syndrome should be offered
earlier and more frequent screening for colorectal cancer. (2012)
(Clinical considerations: http://www.egappreviews.org/docs/EGAPPWG-LynchRec.pdf (7-page PDF. About
PDFs)
Congenital Hypothyroidism
The AAFP recommends screening for congenital hypothyroidism (CH) in newborns. (2008)
(Clinical Considerations: http://www.ahrq.gov/clinic/uspstf08/conhypo/conhyprs.htm#clinical)


Coronary Heart Disease, Adults
Coronary Heart Disease Risk

Assessment, Using Nontraditional Risk
Factors
Dementia, Adults
Dental Caries, in Children from Birth

through Age 5 Year
The AAFP recommends against screening with resting or exercise electrocardiography (ECG) for the
prediction of coronary heart disease (CHD) events in asymptomatic adults at low risk for CHD events. (2012)
Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm#drec
http://www.uspreventiveservicestaskforce.org/uspstf11/coronarydis/chdfinalrs.htm#clinical
screening with resting or exercise ECG for the prediction of CHD events in asymptomatic adults at intermediate
or high risk for CHD events. (2012)
Grade Definition:http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm#irec
http://www.uspreventiveservicestaskforce.org/uspstf11/coronarydis/chdfinalrs.htm#clinical
using the nontraditional risk factors discussed in this statement to screen asymptomatic men and women with
no history of CHD to prevent CHD events. (Select "Clinical Considerations" for suggestions for practice when
evidence is insufficient).
The nontraditional risk factors included in this recommendation are high-sensitivity C-reactive protein (hsCRP), ankle-brachial index (ABI), leukocyte count, fasting blood glucose level, periodontal disease, carotid
intima-media thickness (carotid IMT), coronary artery calcification (CAC) score on electron-beam computed
tomography (EBCT), homocysteine level, and lipoprotein(a) level. (2010)
(Clinical Considerations: http://www.ahrq.gov/clinic/uspstf09/riskcoronaryhd/coronaryhdrs.htm#clinical)
screening for cognitive impairment. (2014)
Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm#irec
http://www.uspreventiveservicestaskforce.org/uspstf14/dementia/dementiafinalrs.htm#consider
The AAFP recommends that primary care clinicians prescribe oral fluoride supplementation starting at age 6
months for children whose water supply is deficient in fluoride. (2014)
http://www.uspreventiveservicestaskforce.org/uspstf12/dentalprek/dentchfinalrs.htm#consider
The AAFP recommends that primary care clinicians apply fluoride varnish to the primary teeth of all infants and
children starting at the age of primary tooth eruption. (2014)
routine screening examinations for dental caries performed by primary care clinicians in children from birth to
age 5 years. (2014)
Depression, Adults
The AAFP recommends screening adults for depression when staff-assisted depression care supports are in
place to assure accurate diagnosis, effective treatment, and follow-up.
"Staff-assisted depression care supports" refers to clinical staff that assist the primary care clinician by
providing some direct depression care and/or coordination, case management, or mental health treatment.
(2010) (Grade: B recommendation)
http://www.uspreventiveservicestaskforce.org/uspstf09/adultdepression/addeprrs.htm#clinical)
The AAFP recommends against routinely screening adults for depression when staff-assisted depression care
supports are not place. There may be considerations that support screening for depression in an individual
patient.
"Staff-assisted depression care supports" refers to clinical staff that assist the primary care clinician by
providing some direct depression care and/or coordination, case management, or mental health treatment.
(2010)
http://www.uspreventiveservicestaskforce.org/uspstf09/adultdepression/addeprrs.htm#clinical)


Depression, Children and Adolescents
Depression, Children and Adolescents
Diabetes, Gestational
The AAFP recommends screening of adolescents (12-18 years of age) for major depressive disorder (MDD)
when systems are in place to ensure accurate diagnosis, psychotherapy (cognitive-behavioral or interpersonal),
and follow-up. (2009)
(Grade: B statement)
(Clinical Considerations: http://www.ahrq.gov/clinic/uspstf09/depression/chdeprrs.htm#clinical
screening of children (7-11 years of age). (2009) (Grade: I statement)
(Clinical Considerations: http://www.ahrq.gov/clinic/uspstf09/depression/chdeprrs.htm#clinical)
The AAFP recommends screening for gestational diabetes mellitus (GDM) in asymptomatic pregnant women
after 24 weeks of gestation. (2014)
Clinical Consideration: http://www.uspreventiveservicestaskforce.org/uspstf13/gdm/gdmfinalrs.htm#consider
screening for GDM in asymptomatic pregnant women before 24 weeks of gestation. (2014)
Clinical Consideration: http://www.uspreventiveservicestaskforce.org/uspstf13/gdm/gdmfinalrs.htm#consider
Diabetes, Type 2, Adults
The AAFP recommends screening for type 2 diabetes in asymptomatic adults with sustained blood pressure
(either treated or untreated)) greater than 135/80 mm Hg. (2008)
Clinical Considerations: http://www.ahrq.gov/clinic/uspstf08/type2/type2rs.htm#clinical
screening for type 2 diabetes in asymptomatic adults with blood pressure of 135/80 mm Hg or lower. (2008)
(Clinical Consideration: www.ahrq.gov/clinic/uspstf08/type2/type2rs.htm#clinical)
Dysplasia (Developmental) of the Hip in
The AAFP concludes that the evidence is insufficient to recommend routine screening for developmental
Infants
dysplasia of the hip in infants as a means to prevent adverse outcomes. (2006)
(Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm#pre)
(Clinical Considerations: www.ahrq.gov/clinic/uspstf06/hipdysp/hipdysrs.htm#clinical)
Falls Prevention in Older Adults
The AAFP recommends exercise or physical therapy and vitamin D supplementation in community-dwelling
adults aged 65 years or older who are at increased risk for falls." See Clinical Considerations for information on
risk assessment. (2012)
(Grade: B recommendation.)
(Clinical Consideration: http://www.uspreventiveservicestaskforce.org/uspstf/uspsfalls.htm)
The AAFP does not recommend automatically performing an in-depth multifactorial risk assessment in
conjunction with comprehensive management of identified risks to prevent falls in community-dwelling adults
aged 65 years or older because the likelihood of benefit is small. In determining whether this service is
appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the
basis of the circumstances of prior falls, co-morbid medical conditions, and patient values. (2012)
(Clinical Consideration: http://www.uspreventiveservicestaskforce.org/uspstf/uspsfalls.htm)
Genital Herpes Simplex Virus Infection,
The AAFP recommends against routine serological screening for herpes simplex virus (HSV) in asymptomatic
Pregnant Women
pregnant women at any time during pregnancy to prevent neonatal HSV infection. (2005)
(Clinical Considerations: www.ahrq.gov/clinic/uspstf05/herpes/herpesrs.htm#clinical)
Genital Herpes Simplex Virus Infection, Non- The AAFP recommends against routine serological screening for herpes simplex virus (HSV) in asymptomatic
Pregnant Adolescents and Adults
adolescents and adults. (2005)
(Clinical Considerations: www.ahrq.gov/clinic/uspstf05/herpes/herpesrs.htm#clinical)
Gestational Diabetes
screening for gestational diabetes mellitus (GDM), either before or after 24 weeks gestation. (2008)
(Clinical Considerations: http://www.ahrq.gov/clinic/uspstf08/gestdiab/gdrs.htm#clinical)
Glaucoma, Adults
screening for primary open-angle glaucoma (POAG) in adults. (2013)
http://www.uspreventiveservicestaskforce.org/uspstf13/glaucoma/glaucomafinalrs.htm#consider)

10

Gonococcal Infection in Neonates, Ocular

Topical Medication
Gonorrhea, Women
Gonorrhea, Men
Healthful Diet and Physical Activity for

Cardiovascular Disease (CVD)
Hearing, Screening Loss in Older Adults
The AAFP strongly recommends prophylactic ocular topical medication for all newborns against gonococcal
ophthalmia neonatorum. (2005)
(Clinical Consideration: www.ahrq.gov/clinic/uspstf05/gonorrhea/gonrs.htm#clinical)
The AAFP recommends screening for chlamydia and gonorrhea in sexually active women age 24 years and
younger and in older women who are at increased risk for infection. (2014)
screening for chlamydia and gonorrhea in men. (2014)
(Grade: I Recommendation)
Although the correlation among healthful diet, physical activity, and the incidence of cardiovascular disease
is strong, existing evidence indicates that the health benefit of initiating behavioral counseling in the primary
care setting to promote a healthful diet and physical activity is small. Clinicians may choose to selectively
counsel patients rather than incorporate counseling into the care of all adults in the general population.
Considerations: General adult population without a known diagnosis of hypertension, diabetes,
hyperlipidemia, or cardiovascular disease. Issues to consider include other risk factors for cardiovascular
disease, a patient's readiness for change, social support and community resources that support behavioral
change, and other health care and preventive service priorities. (2012)
(Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf11/physactivity/physrs.htm#tab1)
http://www.uspreventiveservicestaskforce.org/uspstf11/physactivity/physrs.htm#clinical)
screening for hearing loss in asymptomatic adults 50 years and older. (2012).
Clinical Considerations: This recommendation applies to adults age 50 years and older who show no signs
or symptoms of hearing loss.
Hearing Loss Sensorineural (SNHL)
Hemochromatosis
Hemoglobinopathies, Newborns
Hepatitis B Virus Infection, Pregnant Women
Hepatitis B Virus Infection, in Nonpregnant

Adolescents and Adults
Hepatitis B Virus Chronic Infection
(Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/gradespost.htm#irec)
http://www.uspreventiveservicestaskforce.org/uspstf11/adulthearing/adulthearrs.htm#clinical)
The AAFP recommends screening for hearing loss in all newborn infants. (2008)
(Clinical Considerations: www.ahrq.gov/clinic/uspstf08/newbornhear/newbhearrs.htm#clinical)
The AAFP recommends against routine genetic screening for hereditary hemochromatosis in the
asymptomatic general population. (2006)
(Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf/uspshemoch.htm
The AAFP strongly recommends ordering screening tests for PKU, hemoglobinopathies, and thyroid function
abnormalities in neonates. (2007)
(Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf/uspshemo.htm
The AAFP recommends screening for hepatitis B virus (HBV) in pregnant women at their first prenatal visit.
(2009) (Grade: A recommendation)
(Clinical Consideration: http://www.uspreventiveservicestaskforce.org/uspstf/uspshepbpg.htm)
The AAFP recommends screening for hepatitis B virus (HBV) infection in persons at high risk for infection.
(2014)
http://www.uspreventiveservicestaskforce.org/uspstf12/hepb/hepbfinalrs.htm#consider
The AAFP recommends against routinely screening the general asymptomatic population for chronic
hepatitis B virus infection. (2014)
Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm#brec
http://www.uspreventiveservicestaskforce.org/uspstf12/hepb/hepbfinalrs.htm#consider

11

Hepatitis C Virus Infection, Adults
Hip Dysplasia (Infants)
HIV Infection, Adolescents and Adults
The AAFP recommends screening for hepatitis C virus (HCV) infection in persons at high risks for infection.
The AAFP also recommends offering one-time screening for HCV infection to adults born between 1945 and
1965. (2013)
Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm#poststaskforce.org
Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf12hepc hepcfinalrs.htm#consider
The AAFP concludes that the evidence is insufficient to recommend routine screening for developmental
dysplasia of the hip in infants as a means to prevent adverse outcomes. (2006)
(Clinical Considerations: www.ahrq.gov/clinic/uspstf06/hipdysp/hipdysrs.htm#clinical)
The AAFP recommends that clinicians screen adolescents and adults ages 18 to 65 years for HIV infection.
Younger adolescents and older adults who are at increased risk should also be screened. See the Clinical
Considerations for more information about screening intervals. (2013)
(Grade Definition:http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm#post)
Note:
The AAFPs recommendation differs from the U.S. Preventive Services Task Force (USPSTF) only
on the age to initiate routine screening for HIV. The USPSTF recommends routine screening beginning at age
15 years (insert USPSTF link) and the Center for Disease Control and Prevention (CDC) recommends routine
screening beginning at age 13 years (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm).
HIV Infection, Pregnant Women
Hormone Replacement Therapy
The evidence base for the new recommendations for HIV screening for adults is solid. The one
difference between the AAFP recommendations and those of the CDC and USPSTF pertains to
what age to initiate routine screening. The CDC states age 13 year and the USPSTF
recommendation states age 15 years. The AAFP recommends routine screening starting at age 18
years.
The prevalence of HIV infection and rate of new infection among 13- 14 year olds and 15-17 year
olds are very low. CDC data show for the year 2010 there were 529 AIDS cases and 2,200 HIV
cases in the age group 15-19 years. Based on the most recent US census there are close to 4
million adolescents in each cohort year or a total of 20 million in the ages 15-19. A rough calculation
of (2729/ 20 million) provides a rate of 1.3/10,000. These data are not seroprevalence data and the
actual rates are likely higher. However, these case numbers also include children known to be
infected at birth and thus not all are infections contracted in the adolescent years. In addition the
rate calculated is for the 5 year group and is likely skewed toward the older ages (18 and 19) and
the rates in the 15-17 year olds are probably lower than that calculated.
The benefits of detecting HIV in low risk 15-17 year old versus detecting the infection in the same
adolescent at age 18 is unknown.
The AAFP recommends that clinicians screen all pregnant women for HIV, including those who present in labor
whose HIV status is unknown. See the Clinical Considerations for more information about screening intervals.
(2013)
(Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf13/hiv/hivfinalrs.htm#consider
The AAFP recommends against the use of combined estrogen and progestin for the prevention of chronic
conditions in postmenopausal women. (2012) (Grade: D recommendation)
http://www.uspreventiveservicestaskforce.org/uspstf12/menohrt/menohrtfinalrs.htm#consider)
The AAFP recommends against the use of estrogen for the prevention of chronic conditions in postmenopausal
women who have had a hysterectomy. (2012)
This recommendation applies to postmenopausal women who are considering hormone therapy for the primary
prevention of chronic medical conditions. This recommendation does not apply to women younger than age 50
years who have undergone surgical menopause. This recommendation does not consider the use of hormone
therapy for the management of menopausal symptoms, such as hot flashes or vaginal dryness.
(Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm
http://www.uspreventiveservicestaskforce.org/uspstf12/menohrt/menohrtfinalrs.htm#consider )

12

Hyperbilirubinemia, Infants
Hypertension, Adults
Hypertension, Children and Adolescents
Idiopathic Scoliosis in Adolescents

Illicit Drug Use
Illicit or Nonmedical Drug Use, in

Children and Adolescents
Immunization, Children and Adolescent
Immunization, Children and Adolescent,

Catch-up
Immunizations, Adults
Insulin Dependent Diabetes Mellitus

Iron deficiency Anemia, Pregnant
Women
Iron deficiency Anemia, Children
The AAFP concludes that the evidence is insufficient to recommend screening infants for hyperbilirubinemia to
prevent chronic bilirubin encephalopathy. (2009)
http://www.uspreventiveservicestaskforce.org/uspstf09/hyperbilirubinemia/hyperbrs.htm#clinical)
The AAFP recommends screening for high blood pressure in adults aged 18 and older. (2007)
(Clinical Consideration: www.ahrq.gov/clinic/uspstf07/hbp/hbprs.htm#clinical)
screening for primary hypertension in asymptomatic children and adolescents to prevent subsequent
cardiovascular disease in childhood or adulthood. (2013)
Clinical Consideration: http://annals.org/article.aspx?articleid=1747317#ClinicalConsiderations
The AAFP recommends against the routine screening of asymptomatic adolescents for idiopathic scoliosis.
(2004)
Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf/uspsaisc.htm
screening adolescents, adults, and pregnant women for illicit drug use. (2008)
(Clinical Considerations: www.ahrq.gov/clinic/uspstf08/druguse/drugrs.htm#clinical)
primary carebased behavioral interventions to prevent or reduce illicit drug or nonmedical pharmaceutical use
in children and adolescents. This recommendation applies to children and adolescents who have not already
been diagnosed with a substance use disorder. (2014)
http://www.uspreventiveservicestaskforce.org/uspstf13/drugmisuse/drugmisusefinalrs.htm#consider
The AAFP recommends immunizing all children 0-18 Years of age using the AAFP recommendations unless
contraindicated. (2014)
Recommended Childhood Immunization Schedule: http://www.aafp.org/immunizations.xml
The AAFP recommends immunizing children 0-18 Years who are between doses for vaccinations with the AAFP
recommendation unless contraindicated. (2014)
Recommended Catch-up Immunization Schedule:
http://www.aafp.org/immunizations.xml
The AAFP recommends immunizing all adults using the AAFP recommendations unless contraindicated. (2014)
Recommended Adult Immunization Schedule:
http://www.aafp.org/immunizations.xml
The AAFP recommends against the use of immune marker screening for insulin dependent diabetes mellitus in
asymptomatic persons.
The AAFP recommends routine screening for iron deficiency anemia in asymptomatic pregnant women. (2006)
((Grade: B recommendation)
Clinical Considerations: www.ahrq.gov/clinic/uspstf06/ironsc/ironrs.htm#clinical)
The AAFP concludes that the evidence is insufficient to recommend for or against routine screening for iron
deficiency anemia in asymptomatic children aged 6 to 12 months. (2006)
(Clinical Considerations: www.ahrq.gov/clinic/uspstf06/ironsc/ironrs.htm#clinical)

13

Kidney Disease, Chronic Screening
Lead Poisoning, Children
Lead Poisoning, Pregnant Women
Lipid Disorders, Adults
The AAFP concludes that the evidence is insufficient to assess the balance of benefits and harms for routine
screening for chronic kidney disease (CKD) in asymptomatic adults. Common tests considered for CKD
screening include creatinine-derived estimates of glomerular filtration rate (GFR) and urine testing for
albumin. (2012)
http://www.uspreventiveservicestaskforce.org/uspstf12/kidney/ckdfinalrs.htm#consider)
The AAFP concludes that evidence is insufficient to recommend for or against routine screening for elevated
blood lead levels in asymptomatic children aged 1 to 5 years who are at increased risk. (2006)
(Clinical Considerations: www.ahrq.gov/clinic/uspstf06/lead/leadrs.htm#Clinical)
The AAFP recommends against routine screening for elevated blood levels in asymptomatic children aged 1
to 5 years who are at average risk. (2006)
The AAFP recommends against routine screening for elevated blood levels in asymptomatic pregnant
women. (2006)
The AAFP recommends screening men aged 35 and older for lipid disorders. (2008)
(Clinical Considerations: www.ahrq.gov/clinic/uspstf08/lipid/lipidrs.htm#clinical)
The AAFP recommends screening men aged 20 to 35 for lipid disorders if they are at increased risk for
coronary heart disease. (2008)
(Clinical Considerations: http://www.ahrq.gov/clinic/uspstf08/lipid/lipidrs.htm#clinical)
The AAFP recommends screening women aged 45 and older for lipid disorders if they are at increased risk
for coronary heart disease. (2008)
Lipid Disorders, infants, children,

adolescents, and young adults
Low Back Pain, Adults
The AAFP recommends screening women aged 20 to 45 for lipid disorders if they are at increased risk for
coronary heart disease. (2008)
The AAFP makes no recommendation for or against routine screening for lipid disorders in men aged 20 to
35, or in women aged 20 and older who are not at increased risk for coronary heart disease. (2008)
The AAFP concludes that the evidence is insufficient to recommend for or against routine screening for lipid
disorders in infants, children, adolescents, or young adults (up to age 20). (2007)
(Clinical Considerations: http://www.ahrq.gov/clinic/uspstf07/chlipid/chlipidrs.htm#clinica)
The AAFP concludes that the evidence is insufficient to recommend for or against routine use of
interventions to prevent low back pain in adults in primary care settings. (2004)
http://www.uspreventiveservicestaskforce.org/3rduspstf/lowback/lowbackrs.htm#clinical)

14

Lung Cancer
The AAFP concludes that the evidence is insufficient to recommend for or against screening for lung cancer with
low-dose computed tomography (LDCT) in persons at high risk for lung cancer based on age and smoking
history. (2013)
AAFP Clinical Considerations: The AAFP has reviewed the USPSTF's recommendation on lung cancer screening
and had significant concern with basing such a far reaching and costly recommendation on a single study. The
National Lung Screening Trial (NLST), whose favorable results were conducted in major medical centers with
strict follow-up protocols for nodules, have not been replicated in a community setting. A shared-decision-making
discussion between the clinician and patient should occur regarding the benefits and potential harms of screening
for lung cancer. The long term harms of radiation exposure from necessary follow-up full dose CT scans are
unknown. The USPSTF recommends annual CT screening even though the NLST trial was only 3 annual scans;
further benefit expectations are based on modeling.
The number needed to screen to prevent one lung cancer death over 5 years and 3 screenings is 312. The
number needed to screen to prevent one death by any cause is 208 over 5 years in the NLST trial. Forty percent
of patients screened will have a positive result requiring follow-up, mostly CT scans, although some will require
bronchoscopy or thoracotomy. The harms of these follow-up interventions in a setting with a less strict follow-up
protocol in the community is not known.
In the words of the NLST authors: "The NLST was conducted at a variety of medical institutions, many of which
are recognized for their expertise in radiology and the diagnosis and treatment of cancer." Much of the success of
this trial is based on the low mortality associated with surgical resection of tumors, which may not be reproducible
in all settings.
In the words of the NLST authors: "The cost-effectiveness of low-dose CT screening must also be considered in
the context of competing interventions, particularly smoking cessation."
USPSTF Clinical Considerations:
http://www.uspreventiveservicestaskforce.org/uspstf13/lungcan/lungcanfinalrs.htm#consider
Maltreatment, Children
Motor Vehicle Occupant Restraints
Neural tube defects, Prevention, Folic

Acid Supplementation, Women
Obesity, Adults (Screening for and

Management)
primary care interventions to prevent child maltreatment. This recommendation applies to children who do not
have signs or symptoms of maltreatment. (2013)
(Clinical Considerations :
http://www.uspreventiveservicestaskforce.org/uspstf13/childabuse/childmaltreatfinalrs.htm#consider
The AAFP recognizes the use of motor vehicle occupant restraints is desirable to prevent motor vehicle occupant
injuries. The effectiveness of physicians advice and counseling in this is area is uncertain. (2007)
(Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf07/mvoi/mvoirs.htm#clinical)
The AAFP recognizes that avoiding driving while alcohol impaired is desirable. The effectiveness of routine
counseling of patients to reduce driving while under the influence of alcohol or riding with drivers who are alcoholimpaired is uncertain. (2007)
(Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf07/mvoi/mvoirs.htm#clinical)
The AAFP recommends that all women planning or capable of pregnancy take a daily supplement containing 0.43
to 0.8 mg (400 to 800 g) of folic acid. (2009)
(Clinical Considerations: http://www.ahrq.gov/clinic/uspstf09/folicacid/folicacidrs.htm#clinical)
The AAFP recommends screening all adults for obesity. Clinicians should offer or refer patients with a body mass
index (BMI) of 30 kg/m2 or higher to intensive, multicomponent behavioral interventions. (2012)
Intensive, multicomponent behavioral interventions include behavioral management activities (12 to 26 sessions
in the first year) such as setting weight loss goals, improving diet/nutrition and increasing physical activity,
addressing barriers to change, self-monitoring, and strategizing how to maintain lifestyle changes. See Clinical
Considerations section for more information:
http://www.uspreventiveservicestaskforce.org/uspstf11/obeseadult/obesesum.htm
(Clinical Consideration: http://www.uspreventiveservicestaskforce.org/uspstf11/obeseadult/obesers.htm#clinical)

15

Obesity, Children and adolescents
Oral Cancer, Adults
Osteoporosis, Women
The AAFP recommends that clinicians screen children aged 6 years and older for obesity and offer them or refer
them to comprehensive, intensive behavioral interventions to promote improvement in weight status.
(February 2010)
(Clinical Consideration: (The definitions for specific interventions (targeted to diet and physical activity) and
intensity(>25 hours with child and/or family over 6 months) are noted in the clinical Considers:
www.ahrq.gov/clinic/uspstf10/childobes/chobesrs.htm#clinical)
screening for oral cancer in asymptomatic adults. (2013)
http://www.uspreventiveservicestaskforce.org/uspstf13/oralcan/oralcanfinalrec.htm#consider)
The AAFP recommends screening for osteoporosis in women aged 65 years or older and in younger women
whose fracture risk is equal to or greater than that of a 65-year old white woman who has no additional risk
factors. A 65-year-old white woman with no other risk factors has a 9.3% 10-year risk for any osteoporotic
fracture. (2011)
http://www.uspreventiveservicestaskforce.org/uspstf10/osteoporosis/osteors.htm#clinical)
The FRAX (Fracture Risk Assessment) tool), available at
www.shef.ac.uk/FRAX/, can be used to estimate 10-year risks for fractures for all racial and ethnic groups in the
United States. (2011)
Osteoporosis, Men
Ovarian Cancer, Women
Ovarian Cancer/BRCA Mutation Testing
Ovarian Cancer/BRCA Mutation Testing
Pancreatic Cancer, Adult
Peripheral Arterial Disease
Phenylketonuria, Newborn
screening for osteoporosis in men. (2011)
http://www.uspreventiveservicestaskforce.org/uspstf10/osteoporosis/osteors.htm#clinical)
The AAFP recommends against screening for ovarian cancer in women. (2012)
(Clinical Considerations: Clinical Considerations: http://www.uspreventiveservicestaskforce.org/draftrec.htm)
The AAFP recommends that women whose family history is associated with an increased risk for deleterious
mutations in BRCA1 or BRCA2 genes be referred for genetic counseling and evaluation for BRCA testing. (2005)
(Clinical Consideration: http://www.uspreventiveservicestaskforce.org/uspstf05/brcagen/brcagenrs.htm#clinical)
The AAFP recommends against routine referral for genetic counseling or routine breast cancer susceptibility
gene (BRCA) testing for women whose family history is not associated with increased risk for deleterious
mutations in breast cancer susceptibility gene 1 (BRCA1) or breast cancer susceptibility gene 2 (BRCA2). (2005)
(Clinical Consideration: http://www.uspreventiveservicestaskforce.org/uspstf05/brcagen/brcagenrs.htm#clinical)
The AAFP recommends against routine screening for pancreatic cancer in asymptomatic adults using abdominal
palpation, ultrasonography, or serologic markers. (2004)
http://www.uspreventiveservicestaskforce.org/3rduspstf/pancreatic/pancrers.htm#clinical)
screening for peripheral artery disease (PAD) and cardiovascular disease (CVD) risk assessment with the ankle
brachial index (ABI) in adults
Clinical Consideration: http://www.uspreventiveservicestaskforce.org/uspstf12/pad/padfinalrs.htm#consider
The AAFP recommends ordering screening test for Phenylketonuria in neonates. (2008)
http://www.ahrq.gov/clinic/uspstf08/pku/pkurs.htm#clinical

16

Preeclampsia, Low-Dose Aspirin
Prostate Cancer
Pulmonary Chronic Obstructive Disease
Rh (D) Incompatibility, Pregnant Women
Scoliosis, Idiopathic in Adolescents
Second Hand Smoke
Sexually Transmitted Infections (STIs)
Sickle Cell Disease, Newborns
Skin Cancer, Behavioral Counseling
Skin Cancer, Screening
The AAFP recommends the use of low-dose aspirin (81 mg/d) as preventive medication after 12 weeks of
gestation in women who are at high risk for preeclampsia. (2014)
http://www.uspreventiveservicestaskforce.org/uspstf14/asprpreg/asprpregfinalrs.htm#consider
The AAFP recommends against prostate-specific antigen (PSA)-based screening for prostate cancer. (2012)
(Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/gradespost.htm#drec
http://www.uspreventiveservicestaskforce.org/prostatecancerscreening/prostatefinalrs.htm#consider)
The AAFP recommends against screening asymptomatic adults for chronic obstructive pulmonary disease
(COPD) using spiromtery. (2008)
(Clinical Consideration: http://ahrq.gov/clinic/uspstf08/copd/copdrs.htm#clinical)
The AAFP strongly recommends Rh (D) blood typing and antibody testing for all pregnant women during
their first visit for pregnancy-related care. (2004)
(Clinical Consideration: http://www.uspreventiveservicestaskforce.org/3rduspstf/rh/rhrs.htm#clinical)
The AAFP recommends repeated Rh (D) antibody testing for all unsensitized Rh (D)-negative women at 24-28
weeks gestation. (2004)
(Clinical Consideration: http://www.uspreventiveservicestaskforce.org/3rduspstf/rh/rhrs.htm#clinical)
The AAFP recommends against the routine screening of asymptomatic adolescents for idiopathic scoliosis.
(2004)
(Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf/uspsaisc.htm)
The AAFP strongly recommends to counsel smoking parents with children in the house regarding the harmful
effects of smoking and childrens health.
The AAFP recommends intensive behavioral counseling for all sexually active adolescents and for adults at
increased risk for sexually transmitted infections (STIs). (2014)
Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf13/sti12/stifinalrs.htm#consider
behavioral counseling to prevent STIs in non-sexually active adolescents and in adults not at increased risk for
STIs. (2008)
(Clinical Considerations: http://www.ahrq.gov/clinic/uspstf08/sti/stirs.htm#clinical)
The AAFP recommends screening for sickle cell disease in all newborns. (2007)
(Clinical Considerations: www.ahrq.gov/clinic/uspstf07/sicklecell/sicklers.htm#clinical
The AAFP recommends counseling children, adolescents, and young adults ages 10 to 24 years who have fair
skin about minimizing their exposure to ultraviolet radiation to reduce risk of skin cancer. (2012)
(Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/gradespost.htm#brec)
http://www.uspreventiveservicestaskforce.org/uspstf11/skincancouns/skincancounsrs.htm#clinical)
counseling adults older than age 24 years about minimizing risks to prevent skin cancer. (2012)
(Grade: I recommendations)
(Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/gradespost.htm#brec)
http://www.uspreventiveservicestaskforce.org/uspstf11/skincancouns/skincancounsrs.htm#clinical
using a whole-body skin examination by a primary care clinician or patient skin self-examination for the early
detection of cutaneous melanoma, basal cell cancer, or squamous cell skin cancer in the adult general
population. (2009)
(Clinical Considerations : http://www.ahrq.gov/clinic/uspstf09/skincancer/skincanrs.htm#clinical

17

Speech and Language Delay in Preschool

Children
Suicide, Screening
Syphilis
Syphilis, Pregnant Women
Testicular Cancer
Thyroid Cancer
Thyroid Dysfunction Screening, Adults
Thyroid Function abnormalities, Newborns
Tobacco Use, Adults
Tobacco Use, Pregnant Women
Tobacco Use, Counseling, Children and

Adolescents
Venous Thromboembolism, Genomic

Testing
The AAFP concludes that the evidence is insufficient to recommend for or against routine use of brief, formal
screening instruments in primary care to detect speech and language delay in children up to 5 years of age.
(2006)
(Grade Definition:http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm#pre)
(Clinical Considerations: www.ahrq.gov/clinic/uspstf06/speech/speechrs.htm#clinical)
screening for suicide risk in adolescents, adults, and older adults in primary care. (2014)
(Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm#irec)
http://www.uspreventiveservicestaskforce.org/uspstf13/suicide/suicidefinalrs.htm#consider
The AAFP strongly recommends that clinicians screen persons at increased risk for syphilis infection. (2004)
(Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf/uspssyph.htm)
The AAFP recommends against routine screening of asymptomatic persons who are not at increased risk for
syphilis infection. (2004) (Grade: D recommendation)
The AAFP recommends that clinicians screen all pregnant women for syphilis infection. (2009)
The AAFP recommends against screening for testicular cancer in asymptomatic adolescent or adult males
(2011).
http://www.uspreventiveservicestaskforce.org/uspstf10/testicular/testicuprs.htm#clinical)
The AAFP recommends against the use of ultrasound screening for thyroid cancer in asymptomatic persons.
(1996)
(Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf/uspsthca.htm)
screening for thyroid dysfunction in nonpregnant, asymptomatic adults. (2015)
Grade Definition: http://www.uspreventiveservicestaskforce.org/Page/Name/grade-definitions#irec2
http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/thyroiddysfunction-screening#consider
The AAFP recommends screening for congenital hypothyroidism (CH) in newborns. (2008)
(Clinical Considerations: http://www.ahrq.gov/clinic/uspstf08/conhypo/conhyprs.htm#clinical)
The AAFP recommends that clinicians screen all adults for tobacco use and provide tobacco cessation
interventions for those who use tobacco products. (2009)
(Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf/uspstbac.htm)
The AAFP recommends that clinicians screen all pregnant women about tobacco use and provide
augmented, pregnancy-tailored counseling to those who smoke. (2009)
(Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf/uspstbac.htm)
The AAFP recommends that primary care clinicians provide interventions, including education or brief
counseling, to prevent initiation of tobacco use among school-aged children and adolescents. (2013)
(Grade B recommendation)
http://www.uspreventiveservicestaskforce.org/uspstf12/tobacco/tbacfinalrs.htm#clinical
The AAFP recommends against routine testing for Factor V Leiden and/or prothrombin 2012G> (PT) in
asymptomatic adult family members of patients with venous thromboembolism, for the purpose of
considering primary prophylactic anticoagulation. This recommendation does not extend to patients with
other risk factors for thrombosis such as contraception use. (2012)

18

Violence, Intimate Partner Abuse of Elderly
and Vulnerable Adults
Visual Difficulties, Adults
Visual Impairment, Children
Vitamin, Mineral, and Multivitamin

Supplements for the Primary Prevention of
Cardiovascular Disease and Cancer
Vitamin D and Calcium Supplementation,

Prevention of Fractures in Premenopausal
Women or Men
Vitamin D and Calcium Supplementation,

Prevention of Fractures in
Noninstitutionalized Postmenopausal
Women
Vitamin D Deficiency
The AAFP recommends that clinicians screen women of childbearing age for intimate partner violence (IPV),
such as domestic violence, and provide or refer women who screen positive to intervention services. This
recommendation applies to women who do not have signs or symptoms of abuse. (2013)
(Grade Definition:http://www.uspreventiveservicestaskforce.org/draftrec2.htm)
(Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf12/ipvelderfinalrs.htm)
screening all elderly and vulnerable adults (physically or mentally dysfunctional) for abuse and neglect.
(2013) (Grade: I statement)
(Grade Definition: http://www.uspreventiveservicestaskforce.org/draftrec2.htm)
(Clinical Considerations:http://www.uspreventiveservicestaskforce.org/uspstf12/ipvelderfinalrs.htm)
The AAFP concludes that the current evidence is insufficient to assess the balance of benefit and harms of
screening for visual acuity for the improvement of outcomes in older adults. (2009)
(Clinical Considerations: www.ahrq.gov/clinic/uspstf09/visualscr/viseldrs.htm#clinical)
The AAFP recommends vision screening for all children at least once between the ages of 3 and 5 years to
detect the presence of amblyopia or its risk factors. (2011)
http://www.uspreventiveservicestaskforce.org/uspstf11/vischildren/vischildrs.htm#clinical)
vision screening for children <3 years of age. (2011) (Grade: I Recommendation)
(Clinical Considerations):
http://www.uspreventiveservicestaskforce.org/uspstf11/vischildren/vischildrs.htm#clinical )
the use of multivitamins for the prevention of cardiovascular disease or cancer. (2014)
http://www.uspreventiveservicestaskforce.org/uspstf14/vitasupp/vitasuppfinalrs.htm#consider
the use of single- or paired-nutrient supplements (with the exception of beta-carotene and vitamin E) for the
prevention of cardiovascular disease or cancer. (2014)
The AAFP recommends against the use of beta-carotene or vitamin E supplements for the prevention of
cardiovascular disease or cancer. (2014)
The AAFP concludes that the current evidence is insufficient to assess the balance of the benefits and
harms of combined vitamin D and calcium supplementation for the primary prevention of fractures in
premenopausal women or in men. (2013) (Grade: I recommendation)
(Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/gradespost.htm#arec)
http://www.uspreventiveservicestaskforce.org/uspstf12/vitamind/finalrecvitd.htm#consider)
The AAFP concludes that the current evidence is insufficient to assess the balance of the benefits and
harms of daily supplementation with >400 IU of vitamin D3 and 1,000 mg of calcium for the primary
prevention of fractures in noninstitutionalized postmenopausal women. (2013)
(http://www.uspreventiveservicestaskforce.org/uspstf12/vitamind/finalrecvitd.htm#consider)
The AAFP recommends against daily supplementation with 400 IU of vitamin D3 and 1,000 mg of calcium
carbonate for the primary prevention of fractures in noninstitutionalized postmenopausal women. (2013)
http://www.uspreventiveservicestaskforce.org/uspstf12/vitamind/finalrecvitd.htm#consider)
screening for Vitamin D Deficiency. (2014)(Grade : I recommendation)
http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/vitamin-ddeficiency-screening#consider

19

USPTF Recommendations

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USPTF Recommendations

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Summary of

American Academy of Family Physicians

The AAFP Summary of Recommendations for

The AAFP grading system for those

In 2007, the USPSTF changed the grading of

AAFP Policy Action November 1996,

Where appropriate, specific website URLs are

Services Task Force. The clinical consideration

circumstances that could warrant different

American Academy of Family Physicians

Abdominal Aortic Aneurysm, Men

Abdominal Aortic Aneurysm, Women

Abuse, Intimate Partner Violence of Elderly

Alcohol Misuse, Adults

Alcohol Misuse, Adolescents

Bacteriuria, Asymptomatic, Pregnant

Bacteriuria, Asymptomatic, Men, NonPregnant

AAFP Policy Action November 1996,

American Academy of Family Physicians

Bacterial Vaginosis, Pregnant Women

AAFP Policy Action November 1996,

American Academy of Family Physicians

Breast Cancer, Self BSE

Breast Cancer, Clinical Examination (CBE)

Breast Cancer, Digital Mammography or

Breast Cancer, Prevention Medication

Breast Cancer/BRCA Mutation Testing

AAFP Policy Action November 1996,

American Academy of Family Physicians

Breastfeeding, Structured Education and

Cardiovascular Disease, Aspirin for the

Cardiovascular Disease, Aspirin for the

Cardiovascular Disease, Aspirin for the

Cardiovascular Disease, Aspirin for the

Cardiovascular Disease, Genomic Testing

Carotid Artery Stenosis, Adults

AAFP Policy Action November 1996,

American Academy of Family Physicians

Chronic Obstructive Pulmonary Disease,

Colorectal Cancer, Adults

Colorectal Cancer, Adults

Colorectal Cancer, Chemo Prevention

Colorectal Cancer, Chemo Prevention,

Colorectal cancer, genomic testing

AAFP Policy Action November 1996,

American Academy of Family Physicians

Coronary Heart Disease, Adults

Coronary Heart Disease Risk

Dental Caries, in Children from Birth

AAFP Policy Action November 1996,

American Academy of Family Physicians

Depression, Children and Adolescents

Depression, Children and Adolescents

AAFP Policy Action November 1996,

American Academy of Family Physicians

Gonococcal Infection in Neonates, Ocular

Healthful Diet and Physical Activity for

Hearing, Screening Loss in Older Adults

Hearing Loss Sensorineural (SNHL)

Hepatitis B Virus Infection, Pregnant Women

Hepatitis B Virus Infection, in Nonpregnant

Hepatitis B Virus Chronic Infection

AAFP Policy Action November 1996,